Student Information

Name(Required)

First Last

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Weight Category (Judo)

Favorite Techniques

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Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Alternate Phone

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Referring Party

Name(Required)

First Last

Organization(Required)

Position(Required)

Primary Phone(Required)

Secondary Phone

Email(Required)

Relationship to Applicant(Required)

Specifics of the Stay

Length of Stay(Required)

< 3 months

3-6 months

> 6 months

Undecided

Preferred dates(Required)

Do you want to attend English classes?(Required)

Yes

No

Undecided

Short Essays

If you had to choose just one word to describe yourself, what would you choose?(Required)

Have you ever traveled abroad? What do you know about the United States and Oregon?(Required)

Why do you want to visit / live in the US?(Required)

Why do you want to be admitted to our program?(Required)

What do you hope to gain from your time in Oregon?(Required)

What do you hope to contribute to Pacific Rim and its students?(Required)

What is one thing you respect about your sensei?(Required)

What is one of your greatest achievements? Please tell us about it.(Required)

What do you rate as your greatest personal strengths and weaknesses?(Required)

What is one part of American culture that you are excited to experience?(Required)

What is one part of Japanese Culture that you would like to share with Americans?(Required)

What do you do in your spare time? What hobbies or interests do you have?(Required)

Why do you practice martial arts? Please describe one thing martial arts has done to improve your life?(Required)

In 10 years, where would you like to be living, and what would you like to be doing?(Required)

Exchange Program Application Fee

Please submit your $100 application fee using the payment form below.

Exchange Program Application Fee(Required)

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Japanese Exchange Program Application

Student Information

Referring Party

Specifics of the Stay

Short Essays

Exchange Program Application Fee

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